Transcript Eating Disorders: A Primer for School Providers

Objectives
0 Disordered eating signs and symptoms
0 Review relevant evidence-based treatments
0 Recognize indicators that the child needs a higher
level of care
0 Primary prevention of eating disorders
0 Average model: 5’11”, 117 lbs
0 #1 wish of girls ages 11-17: to lose weight
0 ED’s 3rd most chronic illness in adolescents
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Signs and Symptoms
0 Mirror time
0 Skip meals
0 Weigh frequently
0 Strict exercise
0 Withdrawn
0 Wear baggy clothing
0 Avoid eating in public
0 Evidence of bingeing
0 Signs of purging
0 Bathroom after meals
0 Avoid mirrors/scales
0 Fat talk
0 DIETING!!!
Signs and Symptoms
Psychological
0 Depressed /
irritable
0 Low energy
0 Poor body image
0 Anhedonia
0 Low self-esteem
0 Preoccupied with
nutrition
Physical
0 Brittle nail/hair
0 Syncope
0 Russell’s signs
0 Dry skin
0 Cold!
0 GI pain
0 Weight fluctuations
0 Cavities
Evidence-Based Treatments
0 Very best evidence:
0 Family based therapy (Maudsley approach – for AN)
0 Cognitive behavioral therapy
0 Dialectical behavioral therapy
0 Some evidence:
0 Supportive therapy
0 Interpersonal therapy (BN, BED)
When to refer…
0 Inpatient: (or call 911)
0 <70% ideal body weight
0 irregular vitals/nutrient levels (tube feeding/intravenous
fluids required)
0 not medically stable
0 Residential Treatment, PHP, IOP
0 Usually >70% of IBW
0 lower level of care failed
0 inability to control compulsive behaviors without supervision
(i.e. purging, over-exercising)
0 Outpatient:
0 WVU Disordered Eating Center of Charleston (medical,
dietary, psychological care in state)
0 WV Eating Disorder Network
Primary Prevention of ED’s
0 Create a culture of body acceptance
0 Staff modeling
0 Appropriate responses to body-related bullying
0 http://proud2bme.org/
0 Focus on health behaviors, not weight (e.g., no
calculating BMI’s, assigning kids to use myfitnesspal
for a week, etc)
0 Adopt a “Health at Every Size” perspective
Resources for Providers
0 Treatment Manual for Anorexia Nervosa: A Family Based
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Approach (2nd ed.) by Lock and LeGrange
Eating Disorders in Children and Adolescents: A Clinical
Handbook, edited by LeGrange and Lock
Treating Bulimia in Adolescents: A Family Based Approach,
by LeGrange and Lock
Certification in FBT: http://train2treat4ed.com/
Academy of Eating Disorders (www.aedweb.org)
Fairburn, C.G. “Cognitive Behavior Therapy and Eating
Disorders”. Guilford Press, New York, 2008.
Training in DBT: http://behavioraltech.org/
WVU DECC: http://charleston.hsc.wvu.edu/DECC/